Giving Naloxone by Pre-dosed Injection

At first, giving someone a medicinal drug via injection may seem quite daunting, especially if their life depended on it. However, as long as you remain calm, and remember your training, you should be fine. Because you are dealing with a needle, you need to be aware and be careful of any needlestick injuries. This can range from grazing your finger with the tip of the needle to actually injecting yourself with some of the drug by accident. Again, there will be a higher chance of this happening if you do not remain calm. One of the more common brand names for naloxone by predosed injection is Prenoxad. So first of all, you want to break the seals of the naloxone box so you can open it. Inside the box should be one syringe of naloxone along with two needles. There are two needles in case one is damaged or it gets contaminated before you can give the injection. Once unboxed, twist the grey top of the syringe to unscrew it ready to attach the needle, then take the paper off the back of the needle packaging and carefully take it out. At this point, the needle sheath should still be in place. This is because it's much easier to attach the needle and it reduces the risk of needlestick injuries.

Next, you must carefully screw the blue needle onto the syringe and then carefully remove the plastic sheath exposing the needle. At this point, everything is ready to inject the person with the dose. On the syringe, you should see markers labelling how big each dose should be, and this equates to 0.4 millilitres. To start with, you want to inject them with only one dose. This injection is to be carried out intramuscularly which means you are injecting the medicine directly into the muscle. This helps disperse the drug quickly throughout their body as muscles have a rich blood supply compared with other tissues in the body. To make sure that you are injecting directly into the muscle, there are two sites of the person that you can inject into, the upper outer arm and the upper outer leg. Because the arm is smaller, the correct site can be harder to find, especially for people without a lot of anatomical knowledge. This means that a lot of people prefer to inject into the upper outer thigh. A helpful thing with this type of injection is you can go directly through clothing if necessary.

However, zips and seams should be avoided. Also be aware of anything that may be in the person's pockets and remember that with opioid overdose, there may be contaminated needles. When you are ready, you can push the needle into the leg at a 90-degree angle. This ensures the drug will get deep into the muscle. Once the needle is all the way in, you can then push down on the plunger until you have administered one dose of the drug. It is important you do not give more than one indicated dose. After the drug has been administered, you can smoothly pull the syringe and needle out of the site and put it directly back into the case. Again, at this point, the needle will not only be exposed but you have contaminated it, therefore you should not replace the sheath. It is a very common time for needlestick injuries to occur, so by placing the needle directly back in the box not only do you know exactly where it is, you also avoid harming yourself.

Once the needle and syringe are back in their box, make a note of the exact time the first dose was given. This will be paramount for the paramedics and doctors. This can be done by any means including making a note on your phone, a piece of paper or even using a marker pen to write the time on the patient. The naloxone will start to work in two to three minutes depending on the level of overdose. One dose may not always be enough. If after two to three minutes, there is no sign of them getting better, give them another dose through the same technique. You can use the same needle as long as it is for the same person. After giving the second dose hopefully, the EMS will have arrived and they can take over. Whilst you are waiting for the naloxone to work, putting them in the recovery position is a great way to make sure they do not choke on their tongue as previously discussed. It also allows any fluids such as vomit to not block their airway. Once they are in the recovery position, you should stay with them unless you have to go directly to call the EMS. Ideally, someone else would be doing this. However, as long as they are in a recovery position, they should be okay if you have to leave them for a few seconds.